Download Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)

Basal cell carcinoma (BCC) and
squamous cell carcinoma (SCC)
This information sheet tells you what to expect during your treatment.
Skin cancer support
You can speak to qualified cancer nurses at the Cancer Council
on 13 11 20. They can answer your questions about the effects of
cancer, explain what will happen during treatment and link you to
support groups and other community resources.
If you need an interpreter, call TIS (the Translating and Interpreting
Service) on 13 14 50. For support and advice for carers, call the
Carers Association on 1800 242 636.
1.Initial investigations and referral
Your general practitioner (GP) will examine any suspicious, changing
or rapidly growing skin lesions and may use a magnifying instrument
called a dermoscope to see them more clearly. Your GP may take a
photograph or measurement and instruct you about what to look for
in between appointments.
Your GP should also discuss your needs including physical,
psychological, social and information needs and recommend
sources of reliable information and support.
If skin cancer is suspected, you should have an excisional biopsy.
This will either be done by your GP or they will refer you to a
dermatologist or surgeon.
Excisional Endoscopy
A small surgical procedure where local anaesthetic is
injected into the area near the suspicious growth. The doctor
will remove the spot and a small area of tissue around it
using a scalpel. Stitches will be used to close up the wound
and the sample will be sent to a laboratory for examination.
Note: Skin cancer clinics are not regulated in Australia, so it is
important that you check the practitioner’s credentials when seeking
screening or treatment in a clinic (establish whether practitioner
is medically qualified, and then extent of qualifications in general
practice, skin cancer medicine, surgery or dermatology.)
2.Diagnosis and staging
The biopsy will provide information about whether you have skin
cancer. If you do have a basal cell carcinoma (BCC) or squamous
cell carcinoma (SCC), further surgery to remove a safety margin
of normal skin around the site of the growth is generally necessary
to ensure complete removal. If this is the case, further treatment
might not be required.
Sentinel lymph node biopsy
A small amount of radioactive fluid is injected into the area where
the spot was removed. The lymph node that absorbs the fluid
is removed in a small operation and checked for cancer cells.
In some cases, your GP may refer you to a specialist (a dermatologist
or surgeon) for examination to find any other skin cancers or for further
assessment to check that the skin cancer has not spread to other
parts of your body.
Complete regional lymphadenectomy (LND)
This is an operation to remove the lymph nodes
if the skin cancer has spread.
You may have one or more of these tests:
Surgery in the specialist’s office
In rare instances, your specialist may need to
undertake another biopsy to completely remove
the lesion (a complete excisional biopsy).
Ultrasound-guided fine needle aspiration
The ultrasound uses high-frequency sound waves to create
an image. This is used by the doctor to guide the insertion of
a needle to collect samples of cells. A local anaesthetic may
be given. The cells will then be examined under a microscope.
The doctor will speak to you about your test results and let you
know you if cancer is present. If it is, the doctor will tell you about
its stage of development and if it has spread.
Your GP or specialist should assess your risk for developing further
skin cancers and develop a follow-up plan to pick up any other
BCCs or SCCs should they develop (a dermatological assessment).
For most people, no further treatment is required once
the spot or mole is removed.
For a useful questionnaire to assess your skin cancer risk visit
www.scanyourskin.org/skin-cancer-risk-checklist.
3. Treatment
In cases where the BCC/SCC is in an unusual position or has spread,
your specialist will arrange for a team of health professionals to plan
your treatment based on your preferences and needs.
The team will be made up of professionals who have experience
managing and supporting a person with BCC/SCC.
Your specialist will tell you when the team will be discussing your case.
Your team should discuss the different treatment options with you
including the likely outcomes, expected timeframes, possible side
effects and the risks and benefits. You might want to ask for more
time before deciding on your treatment.
3. Treatment cont’d
Let your team know about any complementary therapies you
are using or thinking about trying. Some therapies may not be
appropriate, depending on your medical treatment.
There are a number of ways to treat BCC or SCC that has spread.
In some cases, more than one type of treatment could be used
to get the best outcome.
Further treatment after surgery for BCC or SCC
Radation therapy (also known as radiotherapy) may benefit
patients with some types of BCC or SCC, especially if surgery
is unsuitable or for recurring BCCs or SCCs.
Non-surgical therapies include:
• cryotherapy (using liquid nitrogen to rapidly freeze the
cancer off) • creams (imiquimod or fluorouracil)
• curettage (scraping) • electrocautery (burning)
• photodynamic therapy (using a photosensitising agent
and laser light).
Chemotherapy may be used for BCC or SCC that has spread
to other parts of the body.
For more information about treatment and treatment side effects ask
your doctor or visit www.cancer.org.au/about-cancer/treatment.
It can be helpful to contact cancer peer support groups and
support groups for carers.
Your doctor should discuss your needs with you during and after
treatment (including physical, psychological, social and information
needs) and may refer you to another service or health professional
for different aspects of your care.
4.After treatment
• the type of follow-up that is best for you
After treatment is completed, your doctor should provide you with
a treatment summary that details the care you received, including:
• diagnostic tests performed and their results
• types of treatment used and when they were performed
• treatment plans from other health professionals
• supportive care services provided to you.
To monitor your health, and to make sure the cancer has not
returned, you will need regular check-ups and undergo annual skin
examinations for life. You and your GP should receive a follow-up
care plan that tells you about:
• care plans for managing any side effects of treatment, should
they occur
• how to get specialist medical help quickly if you think the cancer
has returned or worsened.
Your doctor should:
• discuss your needs with you and refer you to appropriate health
professionals and/or community organisations, if support is required
• provide information on the signs and symptoms to look out for
that might mean a return of the cancer
• provide information on prevention and healthy living.
5.If cancer returns
Sometimes head and neck cancers can come back after treatment. This is why it is important that you have regular check-ups.
Usually this will be detected at your routine follow-up appointments or if you notice symptoms are coming back.
6.Living with cancer
Side effects: Some people experience side effects (for example, tiredness) that continue beyond the end of treatment. Sometimes
side effects can begin months after treatment has finished. For more information about side effects ask your doctor or visit
www.cancervic.org.au/about-cancer/survivors/long-term-side-effects
Advance care plan: Your doctor may discuss with you the option of developing an advance care plan. An advance care plan is a formal
way of setting out your wishes for future medical care. For more information about advance care planning ask your doctor or visit
www.advancecareplanning.org.au
Palliative care: This type of treatment could be used at different stages to help you with pain relief, to reduce symptoms or to help improve
your quality of life. For more information about palliative care ask your doctor or visit www.palliativecare.org.au
7. Questions of cost
There can be cost implications at each stage of the cancer care pathway, including costs of treatment, accommodation and travel.
There can be substantial out-of-pocket costs if you are having treatment in a private health service, even if you have private health insurance.
You can discuss these costs with your doctor and/or private health insurer for each type of treatment you may have. If you are experiencing
financial difficulties due to your cancer treatment you can contact the social worker at your local hospital. For more information about
treatment costs visit www.canceraustralia.gov.au/affected-cancer/living-cancer/dealing-practical-aspects-cancer/costs-treatment
For more information about accommodation and travel costs visit www.cancercouncil.com.au/get-support/practical-support-services
Visit www.cancerpathways.org.au for more information